Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan.
OBJECTIVE
To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting.


METHODS
Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan.


RESULTS
The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths.


CONCLUSIONS
The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.
Kandasamy
Tharani
T
Faculty of Medicine, University of Toronto, Toronto, Canada.
Merialdi
Mario
M
Guidotti
Richard J
RJ
Betrán
Ana P
AP
Harris-Requejo
Jennifer
J
Hakimi
Farima
F
Van Look
Paul F
PF
Kakar
F
F
D000346:Afghanistan / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D007744:Obstetric Labor Complications / Q000401:mortality*; D011159:Population Surveillance; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology*